Week 3 (Labor & Delivery) Flashcards
(87 cards)
1
Q
What are the 5 P’s of L&D?
KNOW THIS!!!!!
A
- Passenger: fetus & placenta
- Passageway: birth canal
- Powers: contractions
- Position of the laboring woman
- Psychology / Psychological Response
2
Q
What is the passenger of the 5 P’s?
KNOW THIS!!!!!
A
Fetus & Placenta
3
Q
What is the Passageway of the 5 P’s?
KNOW THIS!!!!!
A
Birth Canal
4
Q
What is the Powers of the 5 P’s?
KNOW THIS!!!!!
A
Contractions
5
Q
Anterior Fontanelle
KNOW THIS!!!!!
A
- Closes at 12 - 18 months
- Diamond Shaped
6
Q
Posterior Fontanelle
KNOW THIS!!!!!
A
- Closes by 2 - 3 months
- Triangle shaped
7
Q
Where is the sagittal suture located?
A
Between pareital bones
8
Q
Cephalic
A
Toward the head
9
Q
Breech
KNOW THIS!!!!!
A
Buttocks-first presentation of the fetus at delivery
10
Q
Shoulder Presentation
KNOW THIS!!!!!
A
Baby is in transverse position at delivery
- must be turned
11
Q
Proven Pelvis
A
Pelvis that has already delivered a baby
12
Q
Fetal Lie
KNOW THIS!!!!!
A
Relation of the fetus’ long axis (spine) to the mother’s long axis (spine)
- longitudinal / vertical
- transverse / horizontal
- oblique
13
Q
Fetal Attitude
KNOW THIS!!!!!
A
Relation of fetal body parts to one another
- Normal: general flexion with the fetal chin flexed onto the chest & the extremities flexed
14
Q
What is the normal fetal attitude?
A
general flexion with the fetal chin flexed onto the chest & extremities are flexed
15
Q
Fetal Position
A
The relationship of presenting parts to the 4 quadrants of the mother’s pelvis
- LOA, ROA
- ROP, LOP
- ROT, LOT
16
Q
Leopolds Maneuvers
KNOW THIS!!!!!
A
Palpation to determine the fetal lie, fetal attitude, & fetal presentation
17
Q
Fetal Station
KNOW THIS!!!!!
A
A measure of the degree of descent of the presenting part of the fetus through the birth canal
-5
-4
-3 Minimum to rupture; risk of prolapsed cord if not at
-2
-1
0 (baby is engaged)
+1
+2
+3
+4
+5 Birth is imminent
18
Q
Pelvis Shapes
A
- Gynecoid: typical, common, best for vaginal birth
- Android: round, heart-shaped
- Anthropoid: oval
- Platypelloid: flattened
19
Q
Pelvic Inlelt
A
Tip of the pubic bone to tip of the sacrum
20
Q
Pelvic Outlet
A
Bottom of symphysis pubis to the tip of the sacrum
21
Q
Effacement
KNOW THIS!!!!!
A
Thinning & shortening of the cervix
- turtleneck
- in %
22
Q
Dilation
KNOW THIS!!!!!
A
Force of contraction & pressure from presenting part make diameter expand from closed 1 cm to complete 10 cm
- marks the end of the first stage of labor
23
Q
Labor Numbers (4 / 60% / -3)
A
4 cm dilation
60% effacement
-3 fetal station
24
Q
Primary Powers
KNOW THIS!!!!!
A
Involuntary uterine contractions
* Starts labor
* Results in dilation
* adequate & coordinated
25
**Secondary Powers**
| **KNOW THIS!!!!!**
**Bearing down efforts**
* in addition to involuntary contractions
**Ferguson Reflex:** pushing down without trying
26
**Ferguson Reflex**
| **KNOW THIS!!!!!**
Pushing down without trying
27
**Anxiety**
Lead to release of catecholamines = ineffective contractions
28
**Signs of Labor**
| **KNOW THIS!!!!!**
* **Primips:** uterus sinks down "dropped" lightening 2 weeks before
* **Multips:** drop might not happen until true labor
29
**Bloody Show**
A small amount of blood at the vagina from ruptured capillaries when cervix effaces
30
**Braxton Hicks Contractions**
Intermittent painless uterine contractions that occur with increasing frequency as the pregnancy progresses
31
**Labor**
| **KNOW THIS!!!!!**
Process of moving fetus, placenta, & membranes out of the uterus through the birth canal
* **Effacement & dilation of the cervix AND descent of the fetus**
32
**When does risk of infection increase?**
| **KNOW THIS!!!!!**
If amniotic sac has been ruptured for **more than 18 hours**
33
**False Labor**
| **KNOW THIS!!!!!**
**Regular contractions with no cervical change**
* activity has no effect on contractions or decreases
* go away when sleeping
* show not present
34
**True Labor**
| **KNOW THIS!!!!!**
**Contractions that cause cervical change**
* progressive in frequency & intensity
* activity increases & continues during sleep
* **progressive effacement & dilation**
35
**Stages of Labor**
| **KNOW THIS!!!!!**
**1st:** onset of contractions to full dilation
**2nd:** time of full dilation to birth of intant
**3rd:** birth of intant to placenta delivered
**4th:** delivery of placenta till first 2 hours after birth
36
**What is the 1st stage of labor?**
| **KNOW THIS!!!!!**
**onset of contractions to full dilation**
37
**What is the 2nd stage of labor?**
| **KNOW THIS!!!!!**
**Time of full dilation to birth of infant**
38
**What is the 3rd stage of birth?**
| **KNOW THIS!!!!!**
**birth of infant to placenta delivery**
39
**What is the 4th stage of labor?**
| **KNOW THIS!!!!!**
**delivery of placenta until first 2 hours after birth**
40
**7 Cardinial Movements**
**1.)** Engagement
**2.)** Descent
**3.)** Flexion
**4.)** Internal rotation
**5.)** Extension
**6.)** External rotation
**7.)** Expulsion
41
**Fetal Heart Rate**
Reliable & predictive information about the condition of fetus related to oxygen
42
**Maternal Adaptation**
* ↑ Cardiac output 10 - 15%
* ↑ HR
* ↑ BP during contractions
* ↑ WBCs
* ↑ RR
* ↑ Temperature (might, but not always)
* ↑ Proteinuria (might, but not always)
* ↓ Gastric motility
* ↓ Blood glucose
43
**A ------ -------- with an adequate uteroplacental circulation is able to compensate for the stress of uterine contractions.**
Healthy fetus
44
**Opioids**
Medicatiosn that readily **cross the placenta & can have profound effects on the fetus**
45
**Narcan**
Avoid giving this in women that are opioid dependent
* can cause seizures
46
**Epidural**
| **KNOW THIS!!!!!**
* Causes **hypotension**
* **Give fluid bolus of LR 15 - 30 minutes before epidural to prevent hypotentsion**
* **VS Q5 minutes**
47
**Episiotomy**
Incision made to widen the vaginal opening during childbirth
48
**Post Dural Puncture Headache (PDPH)**
**Headache that occurs when the spinal dura is accidentally punctured during an epidural causing a CSF lead**
TX: epidural blood patch
49
**Contraindications for Epidurals**
| **KNOW THIS!!!!!**
* Active hemorrhage
* Hypotension
* Coagulopathy
* Infection
* ↑ ICP
* Allergies
* Cardiac Conditions
* Refusal
WBC must be > 100,000
50
**What is EFM?**
| **KNOW THIS!!!!!**
**Electronic Fetal Monitoring**
51
**Toco Transducer**
| **KNOW THIS!!!!!**
**Measures uterine contractions**
* placed at the fundus
52
**Ultrasound Transducer**
| **KNOW THIS!!!!!**
**Measures fetal HR**
* placed on baby's back
53
**Intrauterine Pressure Catheter (IUPC)**
| **KNOW THIS!!!!!**
**Catheter that measures contraction pressure**
* can only use once amniotic sac has been ruptured
54
**External Fetal Monitoring (EFM) Categories**
**Category I:** normal
**Category II:** indeterminate
**Category III:** abnormal
55
**Fetal HR Variability**
* **Absent: none** (distress, hypoxic, or sleeping)
* **Minimal: < 5 beat difference** from baseline
* **Moderate: 6 - 25 beat difference** from baseline
* **Marked: > 25 beat difference** from baseline
56
**Accelerations**
| **KNOW THIS!!!!!!**
**Good indicator of fetal well-being**
* peaks at least 15 bpm for at least 15 beats
57
**Decelerations**
| **KNOW THIS!!!!!**
Decrease in FHR characterized by shapes & timing
58
**VEAL CHOP**
| **KNOW THIS!!!!!!**
* **V**ariable decelerations **= C**ord compression
* **E**arly decelerations **= H**ead compression
* **A**ccelerations **= O**K
* **L**ate decelerations **= P**lacental insufficiency
59
**Explain the first part of VEAL CHOP.**
| **KNOW THIS!!!!!!**
**Variable** decelerations **= Cord** compression
60
**Explain the second part of VEAL CHOP**
| **KNOW THIS!!!!!!**
**Early** decelerations **= Head** compression
61
**Explain the third part of VEAL CHOP**
| **KNOW THIS!!!!!!**
**Accelerations = OK**
62
**Explain the fourth part of VEAL CHOP**
| **KNOW THIS!!!!!!**
**Late** decelerations **= Placental** insufficiency
63
**Contraction Palpation** (what does the stomach feel like on palpation during a contraction?)
* mild = nose (tip)
* moderate = chin
* strong = forehead
64
**Tachysystole**
| **KNOW THIS!!!!!!**
**5+ contractions in a 10 minute window, over a period of 30 minutes**
* too many contractions!!!
Tx: terbutaline
65
**Early Decelerations**
| **KNOW THIS!!!!!!**
**Mirrors contractions**
* *Cause:* **C**ord compression (**V = C** in VEAL CHOP)
66
**Late Decelerations**
| **KNOW THIS!!!!!!**
**Dip in the fetal heart rate AFTER the peak of the contraction**
* *CAUSE:* **P**lacental insufficiency (**L = P** in VEAL CHOP)
67
68
**Fetal HR Categories**
| **KNOW THIS!!!!!!**
**Category I: normal**
* *110 - 160 bpm*
* accelerations
**Category II: tachy or brady**
* absence of baseline
* no accelerations
* episodic decelerations
**Category III: emergent delivery**
* brady
* hypoxemia
* **sinusoidal pattern**
69
**Sinusoidal Pattern**
| **KNOW THIS!!!!!!**
**Sawtooth pattern** (on fetal heart rate monitor)
* can indicate fetal hemorrhage
70
**What can a sinusoidal pattern on the FHR indicate?**
| **KNOW THIS!!!!!!**
**fetal hemorrhage**
71
**Tachycardia (FHR)**
| **KNOW THIS!!!!!!**
**> 160 bpm**
*CAUSES:*
* ↑ fetal activity
* ↑ maternal fever
* chorioaminitis
* ↓ hypothyroidism
* drugs
* ↓ fetal hypoxemia, anemia, HF
72
**Treatment for Intrauterine Resuscitation**
| **KNOW THIS!!!!!!**
**LIONS PIT**
* **L**eft side lying
* **IV** fluid bolus
* **N**otify physician
* **1.) S**top **Pit**ocin
## Footnote
**STOP PITOCIN = FIRST STEP**
73
**Bradycardia (FHR)**
| **KNOW THIS!!!!!**
**< 120 bpm**
* mild = 80 - 90 bpm
* moderate = < 80 bpm
74
**Variability (FHR)**
| **KNOW THIS!!!!!**
* **Short Term:** speeds up & slows down
* **Long Term:** braod swings in FHR, can be stimulated with examination or loud noise
* **Reduced:** can occur with narcotics, anomalies, & hypoxia
* **Persistent:** in combination with another type of variability to indicate fetal jeapordy
75
**Short Term Variability (FHR)**
**Speeds up & slows down**
76
**Long Term Variability (FHR)**
**Broad swings in FHR**
* can be stimulated with examination or loud noise
77
**Reduced variability (FHR)**
**Can occur with narcotics, anomalies, & hypoxia**
78
**Persistent Variability (FHR)**
**In combination with another type of variability to indicate fetal jeapordy**
79
**First Stage of Labor**
| **KNOW THIS!!!!!**
**Latent:**
* early phase
* regular, painful contractions
**Active:**
* cervical dilation occurs
* **begins @ 6 cm then increases by 1 cm/hr until 10 cm**
80
**Spontaneous Rupture of Membranes (SROM)**
| **KNOW THIS!!!!!**
**1.)** What **time?**
**2.)** What **color?**
**3.)** Is there an **odor?**
* did the cord prolapse? -- check for FHR immediately
81
**GBS**
| **KNOW THIS!!!!!**
**Group Beta Strep**
* **vaginal / rectal culture between 35 - 37 weeks**
* **Receive 2 doses abx prophylaxis** (penicillin) during labor to protect the baby
82
**How often should moms in the 1st stage of labor void?**
Every **2 hours**
83
**Fetal Hypoxia**
Meconium stained amniotic fluid
84
**Second Stage of Labor**
| **KNOW THIS!!!!!**
**Full dilation (10 cm) to birth**
* **Latent:** delayed pushing, laboring down, passive descent
* **Active:** Pushing & urge to bear down (Ferguson reflex)
85
**The application of what type of pressure can cause complications after birth?**
**Fundal**
86
**Third Stage of Labor**
| **KNOW THIS!!!!!**
**Birth of baby to expulson of placenta**
* can bolus oxytocin to clamp down uterus
* counter pressure on the cord to pull away placenta
* **pieces of placenta left in mom can cause hemorrhage - check surface of placenta**
87
**Fourth Stage of Labor**
| **KNOW THIS!!!!!**
**Expulson of Placenta to 2 hours after birth**
* **VS Q5 minutes**
* checking for bleeding / lochia
* empty bladder
* fundal checks
* if C-section = post-op complications
